【摘要】 目的 ：构建血液透析患者分层分级护理评估工具，并检验其信度、效度，为临床开展科学、高效的护理管理提供标准化工具。方法 ：采用文献回顾、质性访谈及德尔菲法构建评估工具初稿。2025年5月—6月，采用便利抽样法选取陕西省某三级甲等综合医院血液净化中心的335例患者进行横断面调查，通过条目分析、评定者间信度检验，并与临床主观护理分级进行比较，筛选条目并形成终版工具。结果 ：终版评估工具包含基础评估（15个条目）和即时评估（11个条目）两部分。工具评估结果与临床主观评判护理级别具有较强一致性（加权Kappa=0.617）。交叉表分析显示，在工具判定护理级别高于主观评判的患者中，多数伴有客观临床风险指标。评定者间信度的Kendall’s W系数为0.817(P<0.001)。结论 ：本研究构建的评估工具具有良好的信度和效度，可为血液透析患者的精准分层分级护理提供客观、科学的评估依据，具备临床适用性。更多还原

【Abstract】 Objective: To develop and validate a tool for hierarchical nursing grading in hemodialysis patients, thereby providing a standardized instrument for clinical nursing practice. Methods: A preliminary tool was constructed through literature review, qualitative interviews, and a Delphi expert consultation. Later 335 patients admitted to a tertiary grade A hospital hemodialysis center from May to June 2025 were conveniently selected as samples for the validation study. In order to finalize the tool, we conducted item analysis, inter-rater reliability testing, and compared the grading results obtained using the tool with the results analyzed subjectively by nurses. Results: The final tool comprised primary assessment(15 items) and instant assessment(11 items). Substantial agreement was observed between the results obtained by the tool and clinical nurses subjectively with a weighted Kappa of 0.617. Cross-tabulation analysis showed that compared with the subjective grading, patients with a higher score according to the tool often tend to have objective clinical risk indicators. Inter-rater reliability testing showed a Kendall’s W of 0.817(P<0.001). Conclusion: The assessment tool demonstrates good reliability and validity, providing scientific basis for the precise stratification and graded nursing of hemodialysis patients.更多还原